18 days in of Venlafaxin - help!

[DanJ1971]

Hello all,

I'm on day 18 of Venlafaxin 75mg and feel awful.
Very anxious, very low thoughts, no appetite, very little motivation.
I'm unemployed (since March) but money not an issue at the moment (thankfully).
I do try and keep as busy as the condition will allow, though that is not always possible.
I do though have 10 year old twins and a wife.
I feel like I can't provide anything in the way of support to them at the moment.
I guess I just need some kind of reassurance that what I am feeling is entirely normal for where I am with the medication and that I will feel some benefit soon.
I have been generally very anxious and low these last 3 weeks, but yesterday I had a horrible anxiety attack and basically just had to lie down, having taken a lorazepam.
Whilst the lorazepam did have some affect, it was not the usual all encompassing calm that I have previously felt.
This has worried me greatly as usually I become relaxed and hopeful after taking it.
I have taken lorazepam as and when I need to for about 3 weeks now, and the usual dose is 1/2 mg every day, sometimes every other day. Yesterday I had to take 1mg tablet. I'm fully aware that I cant take it for too long.

Just looking for some hope/advice/support amidst the thick fog I appear to be in now.

When I saw the doctor 3 days ago (before the horrible episode above), he said 4-6 weeks for the meds to start working, and feeling worse before I feel better is entirely normal. He therefore recommended continuing with the Venlafaxin.

Thank you

[panic_down_under]

I'm on day 18 of Venlafaxin 75mg and feel awful.

Are you on immediate, or slow/extended release venlafaxine? If immediate-release how do you take it?

Very anxious, very low thoughts, no appetite, very little motivation.

These are all typical initial side-effects of ADs, especially the ones which primarily act on serotonin reuptake.

I feel like I can't provide anything in the way of support to them at the moment.

The best way of supporting them is to hunker down and concentrate on yourself for a while. We can't always be all things for everyone.

I guess I just need some kind of reassurance that what I am feeling is entirely normal for where I am with the medication and that I will feel some benefit soon.

Sadly, it is very much the normal response for many. Anyone who tells you that ADs are the easy/lazy path to recovery has never been on them. They can be ornery meds which no one in the right mind, pun not intended, would want to be on. But when they work they can dramatically change lives for the better.

I have been generally very anxious and low these last 3 weeks, but yesterday I had a horrible anxiety attack and basically just had to lie down, having taken a lorazepam. Whilst the lorazepam did have some affect, it was not the usual all encompassing calm that I have previously felt.

That's the increase in serotonin at work. Despite the common claim that serotonin is a 'feel good' neurotransmitter and that these disorders are caused by too little serotonin the opposite is the case. ADs initially do trigger an increase in its synthesis and expression, but biofeedback mechanisms kick-in after a while and greatly reduce both synthesis and expression to well under baseline levels.

This has worried me greatly as usually I become relaxed and hopeful after taking it.

Usually you weren't starting on a new AD.

I have taken lorazepam as and when I need to for about 3 weeks now, and the usual dose is 1/2 mg every day, sometimes every other day. Yesterday I had to take 1mg tablet. I'm fully aware that I cant take it for too long.

The most significant issue with benzodiazepines isn't the dependence most worry about, but that they reduce the effectiveness of ADs. However, not taking them when anxiety levels shoot into the stratosphere is also detrimental, so you're 'damned' if you take them and likely just as damned if you don't. Imho, it is better to lessen the anxiety.

Just looking for some hope/advice/support amidst the thick fog I appear to be in now.

I can't guarantee that venlafaxine will be the right AD for you, but it is as likely to be as any of the others. The only way to know is by sticking with it.

I get the fog. Been there, done that, but didn't get the t-shirt ( darn universal healthcare! ). I had the same reaction on the first AD I was on. I got through it by 'reading', though not reading as it is usually understood. It was mostly looking at each word in turn without much comprehension or retention for about the first month. It was about focussing on something besides the side-effects. It was much the same later when I went back onto ADs after relapses. That was nearly 40 years ago. To this day I don't know what any of the books were about. I should add that I made things much worse by insisting on upping the dose far faster than normal against the advice of my shrink, because I wanted to get back to 'normal' asap to keep my job. Succeeded in that, but not the smartest idea I've had in retrospect.

When I saw the doctor 3 days ago (before the horrible episode above), he said 4-6 weeks for the meds to start working, and feeling worse before I feel better is entirely normal. He therefore recommended continuing with the Venlafaxin.

He's right on all counts, ime. ADs typically kick-in from 4-6 weeks, but it can take up to twice that especially if this isn't the first time on ADs.

[DanJ1971]

Thank you for your support.
I know there is no magic wand 😟.
I am on extended release, and take one tablet at about 9pm.
This is not my first time on AD’s, having taken Paroxetine from 1994 to 2012 end fluoxetine from 2012 to earlier this year.

I will just have to take each section of each day as it comes I think. Just typing this message has helped. I keep getting told this will pass, but feeling well seems like a pipe dream right now.

[panic_down_under]

I will just have to take each section of each day as it comes I think.

Unfortunately, there are no quick or easy treatments, just a hard slog until the brain changes which create the therapeutic response begin having an impact.

I keep getting told this will pass, but feeling well seems like a pipe dream right now.

As the old cliche says it is darkest just before the dawn. (this isn't actually true of the night, but can be of anxiety/depression meds)

[DanJ1971]

I’m updating this thread in case anyone was following and wanted to know how quickly the Venaflaxin might start to work.
I’m on day 30 now and I’m definitely less anxious and less depressed and starting to smile, albeit a little. I think the meds are now making a positive difference although the road is still quite bumpy. Week 3 seemed to be the worst when I nearly decided to stop taking this medication.
I’m cautiously hopeful that I made the right choice to continue. Fingers crossed

[panic_down_under]

4 weeks is at the low end of the range at which ADs typically kick-in so there is probably more improvement to come. You may also need to take a higher dose with most needing 100-225mg for optimum results. The recommended maximum is 375mg/day.

[DanJ1971]

Hopefully yes more improvement to come. If I can I will stay on lowest possible dose for obvious reasons. Thanks for the advice 🙂

[DanJ1971]

Now on day 36 and feel awful again, has been like this the last 4 days and seems to be worsening. I’ve done nothing different to my knowledge that might have caused this. So the question is, does this mean the meds aren’t right for me, is it just a normal blip, or do I need to increase dose? Call made to doctor so I await his call. I’m having to take the odd lorazepam again whereas I recently went 5 days without any at all and I thought I’d got over the worst! 😫🥺😭

[panic_down_under]

So the question is, does this mean the meds aren't right for me, is it just a normal blip, or do I need to increase dose?

It may be one, a combination of them, or something also entirely. Is it worse at one part of the day, or about the same all day? Also have had an infection in the last week or so?

It is still early days. It typically takes 4-12 weeks for an AD to kick-in and because you've been on them before it is likely venlafaxine will do so at the higher end of the range. Blips are also common. It can sometimes be a case of 1 step forward, 2 or more back.

What dose are you now on and when do you take it? Most need 100-250mg/day for optimum results, some need even more. Venlafaxine only begins to inhibit noradrenaline, aka norepinephrine reuptake at doses of 200mg plus, albeit still only weakly.

I'm having to take the odd lorazepam again whereas I recently went 5 days without any at all and I thought I'd got over the worst!

I suspect the improvement owed more to the placebo effect than the med. If you need to take lorazepam occasionally then do so. White-knuckling through anxiety is counterproductive as it reinforces the stress response.

[DanJ1971]

I’ve not had an infection, my physical health has been fine. I’m now on 150mg per day and I take it before bedtime. It seems to be worse in the morning but also in the evening. Woke up this morning feeling VERY anxious. That seems to have subsided now (2 hours later).
As I am currently not working, I find I get panicky at the thought of what am I going to do during the day. I am getting through each day though so this panic feeling is just adding to the mix and clearly not at all helpful. But I can’t seem to shake it.